Status Updates From Principles of Trauma Therap...

The client’s repeated exposure to relational trauma memories- triggered by the therapeutic relationship- in combination with reliable non-reinforcement of the negative expectation leads to a disruption of the learned connection betwn relatedness and danger.
This process of activation->disparity->counter conditioning, when sufficiently repeated (in a safe context) often leads to desensitization of trauma memories.

Clients who have been interpersonally victimized often struggle to notice disparity between suspicion and actual safety. Why?
1. Those exposed to chronic danger often assume such danger is inevitable.
2. In many cases the orig. perpetrator of violence promised safety/caring/support.
3. Therapy implicitly requires intimacy & vulnerability from the client.
Thus, it takes considerable TIME to build trust with client.

As many psychodynamic theorist suggest, activation of relational memories and feelings from the client (transference) towards the therapist should be expected when treating those with childhood (and extended adult) trauma. In fact, activation and exploration of this (relational) material in therapy is often necessary for the successful resolution of chronic interpersonal problems.

Beyond specific/discrete transference triggers, the therapeutic relationship itself (by virtue of its ongoing nature & importance to client) may replicate conditions similar to those of early important relationships, including the client’s need for attachment. To the extent that the earlier relationship was characterized by trauma, the current therap. relationship is likely to trigger negative emotional memories.

Internal Sense of Self:
Early dissociation/other trauma avoidance is likely to block survivor’s awareness of their internal state at the very time sense of self is thought to develop in children. Further, the hypervigilance needed to ensure survival means that much of their attention is directed outward, detracting from internal awareness. Thus there is not safety/allowance for introspection needed to develop self.

The Therapeutic Window:
The range of emotional activation that a client can tolerate without invoking avoidance strategies to block processing. Interventions within the window trigger trauma memories and promote processing, but do not overwhelm internal protective systems (avoidance). Idea is to allow client to slowly process trauma memories without being re-traumatized and needing to shut down the process.

Different theoretical orientations approach cognitive distortions differently.
“The cognitive therapist battles the illogic with logic, while the psychodynamic therapist searches for the logic in the illogical.” (Goin 1997).
Good trauma therapy can provide both: more logical reframing for distorted perceptions, while acknowledging how these distortions made sense at the time/circumstances of the trauma.

Recognizing Disparity:
The experience of anxiety seems to signal danger, and yet when the client does not experience this expected danger it can help reduce their reaction to their own anxiety. As they experience anxiety without being annihilated, they may realize anxiety is merely an emotion and not necessarily a harbinger of danger or loss of control. They can become less anxious about their anxiety.

Cognitive Approaches:
Research suggests that the mere act of writing about an upsetting event, especially if done on multiple occasions, can reduce psychological distress over time. As sequences and details of the event become clearer, there is more material to cognitively process and a greater sense of stability associated with “knowing what happened”.

Cognitive Dimension:
Trauma survivors- esp. victims of interpersonal violence- are prone to self-blame, guilt, shame, low self-esteem, and other negative beliefs and perceptions. The cognitive dimension of trauma therapy involves the guided reconsideration of negative perceptions/beliefs about self, others and the environment that arose from the trauma. Can lead to more affirming/empowering model of self & world.

Identifying Triggers:
1. ID a thought, feeling or intrusive sensation as post traumatic. (ie gunshot, other reminders, etc.)
2. Evaluate stimuli present in the immediate environment and identify which are trauma reminiscent. (ie, rejection, intp. conflict, sirens, etc)
3. Employ an adaptive strategy. (Take a break, get support, breathing, positive self-talk, grounding, etc)

If client is very triggered in-session:
1. Attempt to focus their attention on the therapist & therapy (eg. moving into their visual field)
2. Ask them to briefly describe their internal experience (generally label or describe their feeling)
3. Orient client to the immediate external environment
4. Breathing or other relaxation if needed
* Ensure their reaction isn’t stigmatized nor given too much meaning

Good book recommendations for clients & laypersons:

- Trauma & Recovery by Judith Herman (1992) (“survivor friendly”)
- Coping with Trauma by Jon Allen (2005) (written for the survivor, one of the best)

The Pain Paradox: in an effort to relieve distress survivors may do things that actually increase post traumatic distress and make it more chronic. Our culture teaches that pain is bad & should be removed/medicated/avoided. The paradox is that directly experiencing & engaging with pain ultimately reduces it. The pain paradox suggests that we benefit from staying present in our pain & facing it (to extent possible)

Importance of Compassion:
(can be defined as) nonjudgmental, non-egocentric awareness & appreciation of the predicament and suffering of another with the desire for that person‘s distress to be relieved and their well-being increased.
Unconditional caring directed to the client regardless of their actual presumed good or bad qualities.
Not hierarchical, but rather acknowledging the shared common human predicament.

Broad Components of Effective Trauma Therapy:
1. Overall approach: respectful, positive, compassionate; attuned therapeutic relationship.
2. Psychoeducation on trauma & symptoms.
3. Stress reduction & affect regulation training
4. Cognitive interventions to address harmful beliefs
5. Developing coherent narratives of the event
6. Memory processing. 7. Process relational issues. 8. Increase self acceptance